There and Back Again: The Referral Journey

Abstract

In this issue of Pediatrics , Bohnhoff et al1 reviewed 20\u2009466 pediatric referrals from primary and urgent care offices in the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh system to its affiliated subspecialists. Of these, 65% had an appointment scheduled within 90 days of referral initiation, and 51% had a completed visit within 90 days of referral initiation.1 Appointments with shorter lead times (elapsed time between scheduling the appointment and the date of the appointment) were more likely to be kept. African American race, public insurance, and lower zip code median income were associated with decreased likelihood of both scheduling and completing the appointment. In this study, the authors give a systemwide transparent view of the “administrative friction” experienced by clinicians, referral clerks, and families and provide insight into some of the rate-limiting steps in the referral process.\n\nAs the authors note, this study’s conditions represented a best-case scenario for referrals. Because the referring clinician and the subspecialty schedulers both documented referral information in the same electronic system, the chance of accidental referral loss … \n\nAddress correspondence to Suzanne Berman, MD, Plateau Pediatrics, 3234 Miller Ave, Crossville, TN 38555. E-mail: sberman{at}plateaupediatrics.com